There are several limitations of the present study that caution its ready application in oral health promotion. First, examinations were conducted when the children were only 20-month old. At this age the disease process is at early stage and noncavitated lesions were included in case definition. It is not known how many children or lesions at the noncavitated stage will progress to cavitation and breakdown of crowns of affected teeth. Secondly, no test–retest reliability information was collected. While we accepted that retest created an unwelcome burden for mothers, it left open the possibility of lack of reliability in the dental observations. Thirdly, all mothers were recruited and the intervention administered by the same
author as who conducted the dental examinations. Any recall of group assignment of individual mothers could have biased the dental observations. These concerns call for replication of the study with increased emphasis on blinding and reliability.